A new protocol for severe acute subdural hematoma with cerebral contusion. Intentionally delayed decompressive craniectomy.

Go, Kyoto; Ukai, Isao; Tada, Masatomo; Kuwa, Toshiyuki; Kohno, Masayuki; Sugino, Tatsuya; Kobayashi, Hisashi

doi:10.3893/jjaam.6.641

Cited by 1 publication

(4 citation statements)

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“…3,4) Recently, craniostomy for ASDH has been performed to aspirate the hematoma and control the ICP rapidly in the emergency room preceding decompressive craniectomy. 6,10,11,14,20,31,32) However, without ICP monitoring, the effect of the operation and the indication of further decompressive craniectomy are difficult to estimate. In addition, over-evacuation often leads to acute epidural hematoma in the opposite site.…”

Section: Discussionmentioning

confidence: 99%

“…18,23,30) Surgical intervention for ASDH includes drainage of the hematoma and decompressive craniotomy, which is performed primarily to reduce the increased intracranial pressure (ICP). [5][6][7]21,23) Single burr hole surgery/twist drill craniostomy for ASDH was previously performed to diagnose subdural hematoma, 12) and then to aspirate the hematoma. Currently, the procedure is performed for temporary ICP reduction in the emergency room preceding decompressive craniectomy.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, the procedure is performed for temporary ICP reduction in the emergency room preceding decompressive craniectomy. 3,4,6,10,11,14,20,31,32) However, the effectiveness of emergency craniostomy for ICP reduction is still controversial. Therefore, decompressive craniectomy is often performed routinely even in the absence of indications.…”

Section: Introductionmentioning

confidence: 99%

“…9,19,27,33) In contrast, in the absence of brain contusion or brain swelling, craniostomy and aspiration of the hematoma would improve ICP and further surgery would be unnecessary. 6,31,32) Therefore, monitoring of the ICP during craniostomy in patients with ASDH might provide a method to determine the indications for further surgery. The present study developed a novel method and technique for twist drill craniostomy using a cerebrospinal fluid (CSF) drainage catheter kit, a CAMINO } micro ventricular bolt pressure-temperature monitoring kit (Model 110-4HMT; Integra TM Neurosciences, Plainsboro, N.J., U.S.A.; purchased from Tokibo Co., Ltd., Tokyo).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Novel Method for Emergency Craniostomy for Rapid Control and Monitoring of the Intracranial Pressure in Severe Acute Subdural Hematoma -Technical Note-

Mihara

Dohi

Nakamura

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Acute subdural hematoma (ASDH) is a critical condition following the onset of traumatic brain injury, and it is essential to immediately reduce elevated intracranial pressure (ICP). Single burr hole surgery/twist drill craniostomy is commonly performed in patients with ASDH as an emergency surgical intervention, usually preceding decompressive craniotomy. A novel method using a cerebrospinal fluid (CSF) drainage catheter kit for rapid drainage of ASDH is described. Percutaneous twist drill craniostomy using a CAMINO(®) micro ventricular bolt pressure-temperature monitoring kit was performed in the emergency room in 12 patients with severe ASDH. The kit contained a closed-system CSF drainage and pressure-temperature monitoring catheter, which allowed aspiration of the hematoma and monitoring of the ICP. The tip of the catheter was inserted into the hematoma from the forehead. The mean initial ICP was 61 mmHg, with a range of 31 to 120 mmHg. The liquid hematoma was aspirated, and the ICP was temporarily controlled to the normal range. Pupil dilation recovered immediately after aspiration of the hematoma in 3 patients. No complications occurred either during or after the operation. This new method for craniostomy is easy, safe, and effective to monitor and rapidly control ICP in the emergency room. This technique also offers the possibility of evaluating the patient's prognosis and determining indications for further decompressive craniectomy by the continuation of ICP control under ICP monitoring and evaluation of the reversibility of pupillary findings in ASDH patients.

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